Pulmonary emboli following therapeutic embolization of cerebral arteriovenous malformations in children

Background: Reports of the complicating side effect of pulmonary embolism ( PE) following endovascular therapy of cerebral arteriovenous malformations (AVM) in children have been limited in number. Details of its occurrence ar e yet to be fully elucidated. Objective. The hypothesis is that inadvertent pulmonary migration of emboli c material is common and may go unrecognized. Materials and methods. Forty-seven patients (ages 1 day to 16 years and 11 months) underwent embolization of a cerebral AVM with at least one material (cyanoacrylate, platinum coils, detachable balloons, polyvinyl alcohol par ticles). The medical records and chest radiographs were reviewed retrospect ively. Chest radiographs were available in 34 patients. The radiographs wer e analyzed for the presence or absence of foreign material in the lungs. Results. The chest radiographs in 12 patients (35%) showed pulmonary deposi ts of embolic material; cyanoacrylate in 10 patients and platinum coils in 2. Two of the patients with cyanoacrylate deposits in the lungs developed r espiratory distress that required endotracheal intubation. The patients gra dually improved after a time period of 7-10 days with conservative treatmen t. Conclusion. PE is not an uncommon complication in children undergoing embol ization of brain AVM. Although usually asymptomatic, PE may cause severe sy mptoms.